Training Dental Teams to Address Community Health: Necessary Partnerships and Evaluation of an Evidence-Based Curriculum.

BACKGROUND: Annually, 27 million Americans visit a dental professional but not a physician. Dental professionals must recognize that they are members of their patients' primary care teams. Continuing education must then prepare them to appropriately serve their specific communities. OBJECTIVES: The objective of this paper was to describe the implementation of an evidence-based model to train dental professionals on how to respond to community-level health needs. The paper details crucial partnerships and provides evidence and key considerations for replicating the curriculum to improve population health. METHODS: The Extension for Community Healthcare Outcomes (ECHO) model was used in one state where dental health care use is challenging for persons living rural, eligible for Medicaid, aging, and those who are American Indian. This formative evaluation knowledge assessments, data on participants' changes in clinical care practice, web analytics, and artifact review to assess effective implementation strategies and necessary community partnerships. CONCLUSIONS: Successful implementation of the curriculum required active participation and partnership with state provider associations, the office of Medicaid, the state Board of Dental Licensure, and others. Without engaged partners, the curriculum would not have been community relevant, nor would it have had case presentation from local providers. In a state with only 427 practicing dentists, live attendance ranged between 9 and 22 dental team members, with between 11 and 91 views of the recorded sessions. Using the evidence-based ECHO model, which requires community health partnerships, is a cost-effective, and accessible, method to offering community specific education for dental providers across a large geographic region.

The Case for Community-Based Global Oral Health Immersive Experiences.

We designed and implemented a collaborative immersion in Ethiopia as a service learning experience for a team of interprofessional (IP) learners. The IP team of four dental students, one dental faculty, nine medical students, two medical student leaders, and one global health faculty fully experienced this immersion. The setting was in rural Ethiopia, and the immersive experience included ecological accommodations by the Common River Non-Governmental Organization (CR-NGO).

Practical teaching in undergraduate human and dental medical training during the COVID-19 crisis. Report on the COVID-19-related transformation of peer-based teaching in the Skills Lab using an Inverted Classroom Model.

Objective: Drastic restrictions were imposed due to the COVID-19 pandemic, especially relating to the practical training part of the undergraduate human and dental medical training. During emergency mode teaching in the summer semester of 2020, a pilot project on practical classroom teaching under COVID-19 conditions was undertaken the Skills Lab Dresden, the Interprofessional Medical Training Centre (MITZ). Students were able to continue learning basic communication and manual skills. This project report presents the adaptations needed for this teaching concept and discusses their feasibility as well as selected evaluation results of the trial run. Description of the project: In normal teaching, students rotate to complete training sessions in small groups. Teaching is provided in a peer-teaching format. An Inverted Classroom Model was implemented as a teaching concept during emergency operation with preparation through digital learning and classroom teaching. Organisational and teaching adjustments were carried out for the concept and to comply with containment regulations. The concept was evaluated by the students using a standardised online questionnaire. Results: 1012 students completed their training during emergency operation at the university. The containment regulations meant that there were a higher number of training sessions and a higher workload. Only one of the alternative dates provided had to be used for COVID-19-related reasons. Infection chains could be tracked. The majority of students found the communication of information via Moodle to be sufficient and did not experience any technical problems. An analysis of the students' evaluation revealed a high level of overall satisfaction with the adapted teaching concept. Conclusion: The MITZ will once again use the concept in a modified form should there be renewed or continued emergency operation. The Inverted Classroom Model will also be established as an integral part of regular teaching. The findings may be of interest to other Skills Labs to develop concepts for emergency operation teaching to efficiently utilise site-specific resources.

Antecedentes y Consideraciones para la Renovación Curricular de la Carrera de Odontología de la Universidad de La Frontera, Chile / Background and Considerations for the Curricular Renewal of the Universidad de La Frontera, Chile Dental Degree

El presente artículo tiene por objeto aportar a la discusión y reflexión de los elementos teóricos-conceptuales que debe incorporar un proceso de renovación curricular, en este caso de la carrera de odontología de la Universidad de La Frontera, Chile. Este proceso debe orientarse hacia los nuevos contextos laborales que requiere hoy en día la odontología; estableciendo diseños y lineamientos claros para el desarrollo de los aprendizajes significativosde los estudiantes -con herramientas específicas, saberes interdisciplinarios y competenciastécnicas para la formación integral del profesional-y que a su v ez logre incorporar en todas sus etapas no tan a los estudiantes sino que también a su cuerpo docente. A fin que se logre una apropiación significativa entre todos los actores que participan, adquiriendo un compromiso y alineación con este desafío educativo-formativo, cuyo propósito es la mejora sustancial en la formación profesional odontológica en la región de La Araucanía, Chile.

The objective of this article is to contribute to the discussion and reflection of the theoretical- conceptual elements that should be incorporated in a process of curricular renewal. In this case, concerning the dental degree of the Universidad de La Frontera, Chile, this process should be geared toward the new work context required in the dental field nowadays. Clear designs and guidelines for the development of students' meaningful learning should be established. These should include Interdisciplinary knowledge, technical competences and specific educational tools in a comprehensive educational model for the students and subsequent professionals. Faculty as well as students ought to be included in all stages of this process. To accomplish this challenge in education and training requires a significant and absolute commitment on the part of all players involved, given that the objective is the substantial improvement of the dental professional education in the La Araucanía region.

Desarrollo de un plan integral para la adquisición de la competencia de comunicación en el grado en Odontología de la Universidad del País Vasco: un reto institucional / Development of a comprehensive plan for the acquisition of communication skills in the degree in dentistry at the University of the Basque Country: an institutional challenge

INTRODUCCIÓN: La praxis de la odontología requiere el desarrollo adecuado de las habilidades de comunicación, competencia transversal que ha de estar garantizada durante los estudios de grado. Esto supone un reto institucional, por cuanto las facultades han de poner los mecanismos académicos para evaluar el nivel de desarrollo de dichas habilidades. MÉTODOS: Se plantea un plan integral de carácter colaborativo para el desarrollo de las habilidades comunicativas en el grado en Odontología de la Universidad del País Vasco/Euskal Herriko Unibertsitatea, que contempla cuatro fases: a) recogida y socialización de la información sobre el desarrollo de la competencia; b) diseño de desarrollo trasversal y vertical de la competencia; c) implementación y análisis de resultados; y d) recogida de evidencias del proceso y divulgación de los resultados. RESULTADOS: Tras la detección de las fortalezas y debilidades, se definieron 40 habilidades comunicacionales, estructuradas en cinco bloques (comunicación oral con pacientes/familiares, comunicación oral con otros profesionales, comunicación escrita con pacientes/familiares, comunicación escrita con otros profesionales sanitarios y técnicas de comunicación odontólogo-paciente) y tres niveles de desempeño (identificación de la información, desempeño con alta supervisión y desempeño autónomo con moderada supervisión). Para su desarrollo, se diseñaron 19 actividades formativas y de evaluación, actualmente en implementación. CONCLUSIÓN: El plan se está desarrollando con éxito, y las evidencias del proceso, recogidas en un portafolio, servirán para el seguimiento de la titulación

INTRODUCTION: The practice of dentistry requires the proper development of communication skills, which must be guaranteed during undergraduate studies. This is an institutional challenge, because the schools have to put the academic mechanisms to evaluate the level of development of these skills. METHODS: The University of the Basque Country (UPV/EHU) is developing a comprehensive collaborative plan that includes four phases: a) collection and socialization of information on the current situation of the development of communication skills; b) design of a training plan to improve these skills, c) training plan implementation and results assessment, and d) gathering evidence of the process and dissemination of the results. RESULTS: After the detection of strengths and weaknesses in communication, we defined a total of 40 communication skills, structured in five blocks (oral communication with patients/family members; oral communication with other professionals; written communication with patients/family members; written communication with other health professionals, and dentist-patient communication techniques) and three levels of performance (identifying information, performance with high supervision, autonomous with moderate supervision). For its development, 19 training and evaluation activities were designed, currently being implemented. CONCLUSION: The plan is being developed successfully and the evidence of the process, collected in a portfolio, will be used to monitor the degree

Retrospective investigation of organization and examination results of the state examination in restorative dentistry, endodontology and periodontology under simulated conditions in times of Covid-19 compared to standard conditions when treating patients.

Objective: Primary outcome of this retrospective study was the comparison of state examination results under simulated treatment conditions in times of Covid-19 versus patient treatment under non-pandemic conditions. Additionally, correlation analysis was performed between students' self- and examiners' assessment of the treatment results. Methods: Within 4 hours, 22 examinees each had to place a multi-surface adhesive anterior and posterior restoration, performed an endodontic treatment on a maxillary premolar and a periodontal debridement of one quadrant. All treatments were performed on a model fixed in a phantom head. Compliance with the prescribed hygiene and social distancing guidelines and self-assessment of the practical performance was part of the practical examination as well. One examiner per examination part evaluated anonymously the final results. The historical control was based on the exam results of a cohort from 2019. Mean values (standard deviation), non-parametric correlations (Spearman's Rho) and group comparisons (Mann-Whitney) were calculated for statistical analysis. Results: Examination results under simulated treatment conditions were significantly worse (p<0.05) than in the cohort that took their state exam in patients, with exception of the endodontic partial exam. The overall scores in restorative dentistry and periodontology of both groups, which include a structured theoretical examination, did not differ. The majority of the candidates rated their performance worse than the examiners, and there was no correlation between self- and third-party assessment. Conclusion: In the comparison of two years, a simulated practical examination without patients in restorative dentistry, endodontics and periodontology resulted in matchable results compared with an examination on patients. Equal conditions for the candidates resulting in better comparability and avoidance of ethical dilemmas of patient treatment under examination conditions could also be arguments towards a state examination under phantom conditions in the future.

Teaching Cultural Competence and Cultural Humility in Dental Medicine.

Dental students need to be equipped as clinicians to treat diverse communities and to recognize oral health disparities that are rooted in the social determinants of health. Library instruction is frequently focused on information literacy topics. Within the health sciences this might include critical appraisal or evidence synthesis, and instruction centered on locating and using library resources. This paper details the unique experiences of two liaison librarians to the School of Dental Medicine who taught the topics of cultural competence and cultural humility to first-year dental medicine students. While the authors do not discuss typical information literacy instruction in this paper, they share strategies used to design the instruction sessions, reflections on teaching these themes, lessons learned, and suggestions for other liaison librarians who might have an interest in teaching about cultural competence or cultural humility.

Commentary: Necessity of Blending Dental Education Into the Mainstream of Medical Education as a Specialty Area: Advocating for a Reform Idea Aiming to Promote the Health System Performance in Iran.

With the knowledge we have today about the concept of health and its complexities and determinants, the separation between medical and dental education (DE) does not seem reasonable anymore. Dentistry has mainly developed based on a mechanical approach to treat the related problems. This makes the efforts for reorientation of dental care (DC) toward a preventive approach, relying upon dentists as the chief oral health (OH)-related workforce, inefficient. This is while effective strategies have been identified for prevention, as the key to simultaneously control the burden and costs of the ubiquitous oral diseases, at both individual and population levels without dentists. We think that approaching OH as an integral part of the general well-being requires fundamental changes in the structure of OH system including a substantial revision in the current situation of dentistry as an autonomous health profession with a separate education from the main body of the medicine. In this short article, we briefly discuss the necessity of blending DE into the mainstream of medical education and actual consideration of dentistry as a medical specialty area. After discussing the subject at two levels (health-care system and national levels), the next sections draw attention to some complementary issues.

Call for ACTion: Transforming Dental Education at the University of North Carolina at Chapel Hill.

The University of North Carolina at Chapel Hill Adams School of Dentistry is developing a transformative curriculum that prepares students to enter contemporary practice. The Advocate, Clinician, and Thinker (ACT) framework will provide the basis for developing a resilient workforce capable of meeting emerging health care needs over the next 40 years.

To accept or decline academic remediation: What difference does it make?

Introduction: Academic remediation offered after failure in a knowledge-based progress-test assessment is voluntary and involves student-centered individualized support that helps students to learn most effectively for themselves. This paper explores whether accepting or declining the offer of academic remediation given to struggling students impacts their outcomes both short-term and longitudinally. Method: Data was collated from 2015-16, 2016-17, and 2017-18 and included all students offered academic remediation in the third, fourth, and fifth years of a five-year Dentistry program. Z-scores for each stage and test were calculated and centered on a triggering point; the point at which the offer of remediation was made. These students' average performance post-trigger test and longitudinal performance were analyzed. Results: While performance for both groups significantly improved for the immediate post-trigger test after academic remediation, those that accepted remediation sustained longitudinal improvements across subsequent tests compared to those that declined remediation. Discussion: Through the academic remediation support process students appear to increase their mastery of "learning to learn" and are able to implement sustainable effective learning strategies to carry with them throughout their program. Conclusion: Students who accept academic remediation maintain a more successful academic profile compared to those that do not take advantage of this.

Improving Dental School Clinic Operations Using Business Intelligence Data.

In dental school clinics, students spend a great deal of time waiting for faculty members to check and approve their work. Traditionally at the University of Michigan School of Dentistry, students have left their cubicles to form lines behind supervising faculty members, and this line of students would follow the faculty member around from patient to patient. To address this problem and improve the patient experience, the school computerized the approval-seeking process by building the Faculty Request System (FRS) to enable students to stay with their patients while seeking the necessary approvals. The FRS produced a large volume of time-stamped, business intelligence data that enabled further evaluation. The aim of this study was to assess the effects of this change, including the quality/process improvement interventions that were possible due to information revealed by the FRS. The results showed no change in the number of students or faculty members per clinic session across the three years of this evaluation. With the FRS, the amount of time students spent away from their patients was reduced from 40.6 minutes to 12.1 minutes. After the FRS was implemented, there was an eradication of appointments that ended 30 minutes late (from 0.03% to zero) and a reduction of appointments that ended 15 minutes late (from 0.25% to 0.01%). There were also increases in students' starting appointments on time (9.8% of start checks to 25.8%), 15 minutes late (16.6% to 35.2%), and 30 minutes late (13.2% to 22.2%). By critically analyzing data from the new system, the school's leadership can analyze trends and make data-driven decisions to alter operations. The results of this study suggest that this process can improve the patient and student experience and faculty utilization.

An Adapted Framework for Incorporating the Social Determinants of Health into Predoctoral Dental Curricula.

Social determinants of health (SDH) impact the overall health and well-being of the entire population. It is imperative to train future health care professionals to develop an understanding of the impact of these determinants, so they can provide contextual treatment more conscious of the culturally, racially, and socioeconomically diverse populations they will care for during their careers. This article, the second in a series of American Dental Education Association Commission on Change and Innovation in Dental Education 2.0 white papers on SDH, introduces a conceptual framework adapted from the original framework presented by the National Academies of Science, Engineering, and Medicine that can be applied to predoctoral dental curricula. This framework is organized into three domains: education, organization, and community. The domains are explained, and examples of current implementation efforts at several academic dental institutions are provided to help dental educators envision how to incorporate these concepts into their own curricula.

Female dental students' perceptions of patient safety culture: a cross sectional study at a middle eastern setting.

BACKGROUND: Patient safety is an integral part of all health care specialties, including dentistry. Dental students are exposed to patient safety culture during their clinical training. The aim of this study was to evaluate the perception of female students enrolled in dental degrees and dental hygiene programs towards patient safety culture and to determine its associated factors at a Middle Eastern setting. METHODS: This is a cross sectional study, based on a self-administered, English language questionnaire distributed by convenience among female dental students enrolled in two major Colleges of dentistry in Riyadh, Saudi Arabia. Participants had fulfilled at least one year of clinical training. Sample characteristics included the specialty and years of clinical training. Student's perception was measured using the validated Safety Attitude Questionnaire (SAQ) that consists of 36 statements, distributed over six domains. Responses were rated on a five point Likert scale and the average positive response rate (APRR) was calculated. Binary logistic regression models were constructed to determine factors significantly associated with positive perceptions. RESULTS: The response rate of both student programs was 221/312(70.8%). Students of dental sciences and dental hygiene programs were 133(60.2%) and 88(39.8%) respectively. Almost 42% of students were in their 1st and 2nd years of clinical training. The APRR of: Team Work Climate domain was 54.4 ± 28.0, Safety Climate domain was 51.4 ± 29.7, Job Satisfaction domain was 64.5 ± 33.8, Stress Recognition domain was 56.2 ± 37.8, Perceived Management Support domain was 50.7 ± 37.7, and Working conditions was 55.3 ± 32.1. Female students in their 3rd and 4th year of clinical were adj.OR = 2.3[1.3-4.0] times more likely to have positive perception regarding the team work climate domain when compared to 1st and 2nd year clinical students, P = 0.005. At each of the six individual domains, the odds of having a positive perception were also significantly higher among dentistry students in comparison to dental hygiene students with a range of adj.OR 2.6-4.6. CONCLUSIONS: Apparently patient safety is a concern among female dental students enrolled in dental degree and dental hygiene programs. This requires more attention from the staff, dental college's leadership/management, and faculty/students. Perception of dental students towards patient safety culture is expected to improve with the increase of clinical training.

The Benefits and Challenges of Collaborative Learning: Educating Dental and Dental Hygiene Students Together.

Most often, members of the dental team are educated in separate programs. These professionals then come together in practice to work as a team, often with limited knowledge about each other's roles. The aim of this study was to assess the perspectives of dental and dental hygiene students regarding collaborative learning after taking two courses together. Five years (2010-14) of survey data were collected from a convenience sample of dental and dental hygiene students. The dental hygiene students were in their first and second years (DH1 and DH2) at Eastern Washington University (EWU). The dental students were in the University of Washington (UW) Regional Initiative in Dental Education (RIDE) program, taking their first year of courses in Eastern Washington with EWU's dental hygiene and UW's medical students. Eight first-year dental (D1) students participate in the RIDE program each year, totaling 40 across the five years. Because the same D1 students take both courses, this target population was 80. The number of DH1 and DH2 students in these courses ranges from 32-36 each year, for a target population of 323 across the five years. A total of 193 survey responses were collected, for an overall response rate of 48%; the D1 response rate was 72%, and the DH response rate was 42%. In the results, students perceived that learning collaboratively helped them think positively about other dental professionals, benefitted their problem-solving skills, increased their understanding of clinical problems, helped them become better team members, improved trust and respect, and improved their understanding of course content. These results suggest that collaborative learning had a positive impact on both groups. In comments, students suggested they would benefit from more shared learning experiences in the clinic and agreed that collaborative learning would help them create a more cohesive team.